Provider Demographics
NPI:1619595485
Name:REHEMA BEHAVIORAL HEALTH CLINIC LLC
Entity Type:Organization
Organization Name:REHEMA BEHAVIORAL HEALTH CLINIC LLC
Other - Org Name:HOLY TRINITY BEHAVIORAL, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEMBOI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-256-7755
Mailing Address - Street 1:8435 W HUGHES DR
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-3902
Mailing Address - Country:US
Mailing Address - Phone:623-256-7755
Mailing Address - Fax:
Practice Address - Street 1:4541 N 12TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-4203
Practice Address - Country:US
Practice Address - Phone:602-481-3575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-08
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty